- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $77.62 / $138.04
| Facility | | $14.45 | $77.62 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.18 / $39.81
| Professional | | $10.96 | $13.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $10.23 / $33.11
| Professional | | $4.07 | $10.23 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $54.95
| Facility | | $30.90 | $45.71 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $9.55 / $13.49
| Professional | | $6.61 | $9.55 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $30.20 / $67.61
| Facility | | $10.23 | $30.20 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $10.00 / $22.39
| Professional | | $7.59 | $10.00 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $27.54 / $33.88
| Professional | | $12.30 | $27.54 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $12.88 / $28.84
| Facility | | $11.75 | $12.88 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $23.99 / $26.92
| Professional | | $11.75 | $23.99 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $398.11
| Facility | | $194.98 | $194.98 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $14.79 / $25.70
| Facility | | $7.41 | $14.79 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $10.23 / $20.42
| Professional | | $6.17 | $10.23 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $100.00
| Facility | | $70.79 | $70.79 | $100.00 |